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    020489

    Breast feeding: fertility and contraception.

    Kleinman RL; Senanayake P

    London, International Planned Parenthood Federation, 1984. 43 p. (IPPF Medical Publications)

    This booklet, for health care workers in developing countries, reviews the fertility-controlling effects of breastfeeding, its strengths and limitations as an element in family planning, and how to provide modern methods of contraception to lactating women. Breastfeeding currently provides about 30% more protection against pregnancy in developing countries than all of the organized family planning programs. The recent trend toward a falling off in the practice of breastfeeding poses a threat to infant welfare and a danger of increased fertility. Health workers are urged to reach pregnant women in the community with knowledge about the value of breastfeeding versus bottle feeding. Each country must set its own policies concerning contraception for lactating women. It is preferable for lactating women to use nonhormonal methods, but if selected, they should not be used too early. Lowest-dose preparations, especially progestogen-only pills, are preferable. Determination of when to start contraception during lactation should be based on breastfeeding patterns in the community, the age at which supplementary foods are introduced, usual birth spacing intervals, and the mean duration of lactation amenorrhea. If the usual time of resumption of menstruation in a given community is known, a rough guide to the optimal time for starting contraception is returning menstruation minus 2 months.
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